Building Cultural Competence
“We have become not a melting pot but a beautiful mosaic. Different people, different beliefs, different yearnings, different hopes, different dreams.”
The Spirit Catches You and You Fall Down is a critically acclaimed book that Anne Fadiman has written about the struggle between Western medical doctors and providers and the traditional healing practices of the Hmong. In the book, differing cultural views come into conflict as both sides work to help a little girl named Lia, who has epilepsy. Ultimately, this conflict led to a disastrous conclusion for all parties involved. Lia had a severe seizure that left her in a vegetative state.
Professor Hee Yun Lee, Ph.D., of the University of Minnesota’s School of Social Work, documented a similar cultural clash when she conducted a focus group with local healthcare providers. She wanted to learn more about health disparities affecting culturally diverse elders in the Twin Cities. One orthopedist talked about his experience in treating an elderly Hmong woman who fell and broke her wrist.
After examining the woman, the orthopedist placed a cast on her wrist. The doctor asked her to report back in two weeks for a check-up. When she came back, her cast was off. The orthopedist was upset; he applied another cast and told her to keep the cast on her wrist to allow the bone to heal. The interpreter translated the doctor’s instructions and asked if the patient understood. The woman smiled, nodded, and said, “Yes, yes.” When she went back to the doctor two weeks later, the cast was off again. The orthopedist now was really upset. Through the interpreter, the doctor told her that her wrist would not heal without the cast.
The woman then went to a young female Hmong family doctor. The elderly woman trusted her new doctor and asked how her arm would heal if the shaman couldn’t put healing herbs on it. The new doctor put a special cast on her arm with a removable top to allow the shaman to put herbs on her arm. This solution allowed the woman to heal both through Western medicine and traditional Hmong treatments.
This example illustrates how Hmong history, health beliefs, and family structure can affect the effectiveness of western medicine with a Hmong patient. Dr. Lee has been researching the need for health literacy and cultural competency when working or interacting with diverse older adults in the community. She created an online educational module to increase providers’ cultural competency and their understanding of culturally based health practices.The paragraphs below are a summary of parts of the educational module:
Hmong tribes lived in the mountainous areas of China and Laos before the Vietnam War began. During the war, the United States recruited Hmong men to fight with them against Northern Vietnam, and they became important allies of the United States. When Laos and Vietnam fell to the communists, some Hmong were able to seek refuge in Thailand. Many more were forced to walk to refugee camps. The United States, together with other countries, granted the Hmong refugee status to address overcrowding and unpleasant living conditions in the refugee camps. The time spent as refugees in the camps and their initial life as immigrants to the United States was very difficult for the Hmong, who previously had an agricultural lifestyle and had never been exposed to indoor plumbing, kitchen appliances, or grocery stores. Learning a new language also proved challenging because the Hmong were preliterate. They didn’t have a written language until 1950, making acculturation difficult.
The Center for Cross Cultural Health in Minneapolis provides an excellent overview of traditional Hmong health beliefs. Traditional Hmong believe that the primary cause of illness is loss of the soul. The soul may leave the body when a person is depressed, is lonely, has experienced loss, or is frightened. Stanford University’s Geriatric Education Center notes that having an accident, experiencing a scary event, or angering a spirit can cause soul loss in the traditional Hmong belief system. To bring the soul back to the sick person, Hmong seek the help of a shaman. The shaman is a healer who can communicate with the spirit world and locate the missing soul. Family members often make decisions about a Hmong person’s medical care. A clan elder, father, older brother, uncle, in-law, shaman, and/or the wider community may become involved in decisions about a person’s care.
Since the Hmong came from a preliterate society, historically they have passed on their traditions through storytelling, tapestries, and folk songs. The Hmong family does not consist of a nucleus of mother, father, and children. The clan is the important familial tie. Numerous clans exist, each of which has a different surname such as Vang, Lee, or Thao. Members of each clan are very close, and the clan designates an elder male as the leader. Hmong families are patrilineal, and they trace their family histories through the father’s side. Traditionally marriages occurred by arrangement. Brides were often kidnapped and widows married brothers-in-law. Education and acculturation are decreasing the prevalence of these traditional practices among the Hmong.
To learn more about Hmong culture come to the VAN Forum on Tuesday, November 10, at 10:30 a.m.